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HomeMy WebLinkAboutBENSON #3 LT 7 Municipality of Anchorage Community Development Department Page 1 of 2 On-Site Water and Wastewater Program 4700 Elmore St. • P.O. Box 196650 Anchorage,AK 99519-6650 • http://www.muni.org/onsite•(907)343-7904 ON-SITE WASTEWATER INSPECTION REPORT Permit Number: OSP181243 PID Number: 051-281-75 ❑ New 0 Upgrade Name: DAVID BARBER ABSORPTION FIELD Address ❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound 17824 KAMKOFF AVE ❑ Other Phone Number of Bedrooms Soil Rating Total depth from original grade 4 GPD/SF Ft. LEGAL DESCRIPTION Depth to pipe invert from original grade Gravel depth beneath pipe Subdivision Block Lot Ft. Ft. BENSON#3 7 Fill added above original grade Gravel length Township Range Section Ft. Ft. Gravel width Beds:Number of Lines Distance between lines SEPARATION DISTANCES Ft. Ft. To Septic Absorption Holding; Sewer Total absorption area Number of trenches Dist.between trenches From Tank Field Lift Station I Tank Line Ft2 Ft. Well 127.9 N/A N/A N/A N/A TANK ❑r Septic ❑S.T.E.P. 0 Holding 0 Other Manufacturer Capacity Surface Water 100+ N/A N/A 1 N/A Anchorage Tank 1000Ga1. 1 Material Number of compartments Lot Line 16.3 N/A N/A N/A Steel 2 NA Foundation 10.3 N/A N/A N/A LIFT STATION Manufacturer Capacity Curtain Drain 50+ N/A N/A N/A Gal. Remarks Pump on level at Pump off level at High water alarm at TANK REPALCE ONLY in. in. in. Pump make and model Electrical Inspections performed by PIPE MATERIAL House to tank 3034 Tank to 3034 Installer drainfield JR's Septic Pumping Drainfield CO/MT Inspector PES BENCH MARK (Assumed elevation) 292 ft InspdationeS 1'' 8/8/2018 2"d 8/10/18 Location and description 3rd 4th AT HOUSE POINT A COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL Engineer's Stamp Conditional Approval: Date �',�OF •AL.,„ it,A. S i 0) . �-�'' .q 1� s*• 49TM 1' •.* / Meyer". 'Van nolae li 63,—LS r cam`• CE�9. •�% Approved ln--(: Date / 4kll �A ... Inspection Report_1-1-12.doc I / / 1 I / / M —� M J I \ , J 1 — / \ / A / 2;, I> 4, \ _ / N =( / I _ --7 Ar 1 a, u. ...r \ N \ --- 1 \ 300- / / /� ' — / c\ _ / N. m \ \� WELL (E) 1� / / \ \ \ \/f W W N L _ ,, / �KAMKOFF AVENUE---, , \ \ \ I „Ns \ lei e e!�e�c.rit sr� N 295 - - \ \ 275 26\ 265 290 DRIV AY / 2701 / \ I \ \ \4265 �_ N. N N \ INSTALLED 1000g SEPTIC TANK' \ \260 \ `N. N \ N N. N ` § —W/ DCO AFTER CONNECTED TO \ \ \ N N N N N N. N 127 • T2 MIDDLE OF EXISTING TRENCH 255 NN. \ N N. •T 1 -----------------\__u \ C\ N. N \ \ \ N N. \ 3 \ -„ \� \\ N \ N \\�\ \ BDDR �' 113.8 \ WELL E 250 \ N \ N _ ♦ 4,1 • N \ \ \ N \ I \ \ \ \ \ N N \ \ \ \ \\A•\\A•\ \ N W \ \ \REMOVED EXISTING SEPTIC/—, 2 16 4 1 N N N TANK PER MOA CODE DCO — .3 r 1 N N \ • \ \ N \ \ \ 1 /\ / / 1 N. NN N J / \ '---, \ N \ J / N NN N N \ \ W / A B N. N N N. \ N N.\ N ` — — N. 1 Ti 15.8 10.0 N. \ \ \ \ \ \ — 1 1 T2 14.2 13.0 . \ . \ \ N N \ ,,,, \ — / • N I DCO 21.1 18.0 \ \ \ \ N. N. - - -- \ \� M ------- N \ \ \ N \ . \ \ I— I— I— O O w O J OD J J O J U o 0 _ OG.FG. 292.5 4.8 1 1000g `— ` 286.7/ SEPTIC \286.9 TANK PROFILE SCALE: NTS NOTES: PANNONE ENG SVC, LLC Dat8/10/18 RECORD DRAWING P.O. BOX 102954 ANCHORAGE, AK 99510 PHONE (907) 272-8218 FAX (907) 272-8211 • Scale *1414 .* 1- = so. ••• •• •+ P.I.D. NO BENSON #3 L7 051-281-75 DRAWN ACP DAVID BARBER '� 8149 PERMIT N0. 17824 KAMKOFF AVE •, IV:08/15/201 OSP181243 SITE PLAN EAGLE RIVER, AK 11 :A j, Sheet 2 OF 2 N,"P""ri. MUNICIPALITY OF ANCHORAGE ocnt On-Site Water&Wastewater Program S• PO Box 196650 4700 Elmore Road '_ '4'x AAS', Anchorage,Alaska 99519-6650 Phone:(907)343-7904 Fax: (907)343-7997 http://www.muni.org/onsite 111161-1-1.-11 I)cpartntcnt 4 CHpq PGS On-Site Wastewater Disposal System Permit Permit Number: OSP181243 Effective Date: 8/3/2018 Work Type: SepticTank Upgrade Expiration Date: 8/3/2019 Tax Code Number: 05128175000 Site Legal Address: BENSON #3 LT 7 G:0753 Site Mailing Address: 17824 KAMKOFF AVE, Eagle River Owner: BARBER DAVID R Lot Size in Sq Ft: 52412 Design Engineer: PANNONE ENGINEERING SERVICES Total Bedrooms: 3 This permit is for the construction of: ❑ Disposal Field 0 Septic Tank 0 Holding Tank 0 Privy 0 Private Well 0 Water Storage All construction shall be in accordance with: 1. The attached approved design. 2. All requirements specified in Anchorage Municipal code Chapters 15.55 and 15.65 and the State of Alaska Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80) 3. The wastewater code requires inspections during the installation. The engineer shall notify the Development Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (24/7). 4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather shall be either: a. Opened and Closed on the same day, or b. Covered, sealed, and heated to prevent freezing Received By: ,( Date: i Issued By: 6tf'CU �1�sic Date: g 3 er glifEraNcy Elv\FE-e-eN\c --.1 MUNICIPALITY OF ANCHORAGE Eputtms •Community Development Department Phone: 907-343-7904 Development Services Division Fax: 907-343-7997 On-Site Water&Wastewater Program ON-SITE SEWER/WELL PERMIT APPLICATION Parcel I.D. 051-281-75 Property owner(s) DAVID BARBER Day phone Mailing address 141 COUNTRY CLUB DRIVE CRAWFORDVILLE, FL 32327 Site address 17824 KAMKOFF AVE EAGLE RIVER, AK Legal description(Sub'd., Block& Lot) BENSON #3 LOT 7 Legal description(Township, Range &Section) Lot Size 52,412 Sq. Ft. Number of Bedrooms 3 APPLICATION IS FOR: APPLICATION IS AN: TYPE OF DWELLING: (®all that apply) Absorption Field ❑ Initial ❑ Single Family(SF) ❑1 (w/wo ADU) Septic Tank ❑X Upgrade 0 Duplex(D) El Holding Tank ❑ Renewal ❑ Multiple Dwellings ❑ Privy ❑ (SF and/or D) Private Well ❑ Water Storage ❑ THIS APPLICATION INCLUDES A VARIANCE/WAIVER REQUEST FOR: Dis tance: I certify that the above information is correct. I further certify that this is in accordance with applicable Municipal Codes. (Signature of property owner or authorized agent) Permit/Rush Fees: oZls Waiver Fees: Date of Payment: 2la-tie Date of Payment: Receipt Number: 0573104 Receipt Number: Permit No. OSPIglAtt3 Waiver No. Permit App_>: .-...c Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPUMCE Pannone Engineering Services LLC osP181243, Rebecca Carroll, 08/03/18 Steven R. Pannone, Principal Registered Professional Engineer E-mail: steve@Panenaak.com July 27, 2018 Municipality of Anchorage Development Services Department On -Site Water & Wastewater Program 4700 S. Bragaw Street Anchorage, Alaska 99519 Subject: Benson #3 , Lot 7 Ladies and Gentlemen: I arm writing to request that a permit to install a new 1000 gallon septic tank be issued for this lot. The proposed systems will serve an existing three-bedroom house. Currently the lot is developed. The existing 1000 gallon septic tank is in failure. The existing tank will be removed per MOA code. The existing tank is located outside the 100' well radius, the proposed tank will be placed outside the 100' well radius. The surrounding lots are served by private wells, and there are no wells within 100 feet of the proposed septic tank.. PES will verify all required separation distances at time of installation. 1. Upgrade Tank Design. a. See Sheet 1 of 1 of the plan set 2. Surface Water: There is no surface water within 100 feet of the proposed system. The proposed systems will maintain at least 100 feet from all surface water and drainage ditches. 3. Topography: Lot 7 slopes from northeast to southwest at approximately 2% in the area of the tank replacement. The proposed installation will be located in the northeast portion of the lot next to the existing septic tank and absorption system. Page 2 of 2 The proposed installation will not affect the future development of the surrounding or existing lots. There are no wells or septic systems within 100 feet of the proposed septic location. If you have any questions or concerns, please contact me at 272-8218. Sincerely. Sfeven ZRP Owner/Civil Engineer Attachments: I Municipality of Anchorage On-site Water and Wastewater REVIEWED FOR CODE COMPLIANCE OSP181243, Rebecca Carroll, 08/03/18 MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH & ENVIRONMENTAL PROTECTION ENVIRONMENTAL ENGINEERING DIVISION 825 L Street- Anchorage, Alaska 99501 Telephone 264-4720 ON-SITE SEWAGE DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT NAME PHONE ~NEW [] UPGRADE iLOCATION/ / I ' ~ z ~. NO. OF BEDROOMS .......... ]Well ~V~J~r~'-~-AbsorPtion area~ ! I Dwelling f/~ I PERMIT NO. -~ ~ Manufacturer ~ ~ __ _ M~i~ ~ ~ No. of compartments ~ Liq. ap it in lions ............ Inside length Width Liquid depth ' DISTANCE TO Well Dwelling PERMIT NO. Manufacturer /~ Material Liquid capacity in gallons Well ~ Foundation ~ Nearest ct line ~ PERMIT NO ~ ~ D~STANCE TO: ~ -- /~ '/~ /~ I ' ~' ~ ~ No. of lines ~ Length of ea~ ' Total ~ ~ lin~' Trench w~ Distance between lines ~ . , (. , I~ ~ /~ inches ~ Top ct ti~e to tinisn grade ~ J ' Material beneath tile ~ ~ ~ Total eff~tiv~absorD~n area Length Width tDepth ~ PERMIT NO, Type of crib Crib diameter '/' ~rib depth Total effective absorption area DISTANCE TO: Well Building foundation Nearest lot line Class ---- / Depth~ ~ . j ~ ~r~ ~ / / Distance to lot line PERMIT NO. ~/~AI-~ ~ I ~ I I/V/~ I DISTANCE ¢ ~ ~TO:" Buildi~u~d~tio~ ~ ;ewe~ line' - ~ Septic tank 1 Absorption area(s) OTHER PIPE MATERIALS SOIL TEST RATING / INSTALLER REMARKS 7~013 (Rev. 3/78) DATE LEGAL MUNICIPALITY OF ANCHORAGE Department f Health and Environmenta Protection 825 ~ Street, Anchorage, AK. ~9501 264-4720  * * * HANDWRITTEN PERMIT * * * AND/OR -SITE SEWER PERMIT ~ f Permit ~ ~L ON Applicantl ~ ~--~s~. Mailing Location: Phone Number: Legal Description: /~3~ ~3~ ~?D--/~/ /~~/ Lot Size: Type of Soil Absorption System Is: Trench: ~ Drainfield: Seepage Bed: Holding Tank: Maximum Number of Bedrooms: Soil Rating (sq. ft/br) ~/~. The Required Size of the Soil Absorption System Is: ¢ / WIDTH The length dimension is the length(in feet) of the trench or drainfield. The depth of a trench or pit is the distance between the surface of the ground and the bottom of the excavation(in feet). There is no set width for trenches. The gravel depth is the minimum depth of gravel between the outfall pipe and the bottom of the excavation(in feet). · REQUIRED SEPTIC(HOLDING) TANK SIZE = //~/~O GALLONS Permit applicant has the responsibility to inform this department during the installation inspections of any wells adjacent to this property and the number of residences that the well will serve. · * * TWO(2) INSPECTIONS ARE REQUIRED * * * Backfilling of any system without final inspection and approval by this department will be subject to prosecution. Minimum distance between a well and any on-site sewage disposal system is 100 feet for a private well or 150 to 200 feet from a public well depending upon the type of public well. Minimum distance from a private well to a private sewer line is 25 feet and to a community sewer line is 75 feet. Well logs are required and must be returned to this department within 30 days of the well completion. Other requirements may apply. Specifications and construction diagrams are available to insure proper installation. * * * PERMIT EXPIRES DECEMBER 1 9 8 3 * * * I certify that: (1) I am familiar with the requirements for on-site sewers and wells as set forth by the Municipality of Anchorage. (2) I wil~nstall the~ystem in accordance with codes. ~ (3) I under~ta~d th~e on-site sewer system may require enlargement : Tanned Signe~' ths~ re~ce~'~em°deled to include more tha~ 3 bedrooms.~ _ ~licant Date: ~-- / ~--~ if SWP/024 (1/81) [] SOILS LOG MUNICIPALITY OF ANCHORAGE DEPARTMENT OF HEALTH AND ENVIRONMENTAL PROTECTION 825 L. Street, Anchorage, Alaska 99501 264-4720 SOILS LOG - PERCOLATION TEST PERCOLATION TEST DATE PERFORMED: LEGAL DESCRIPTION: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 ,; 20 COMMENTS SLOPE SITE PLAN .<;i,4 ,- c ,'/ ..?~..~ I~/ ~~' . ~/.~ .~ i No. 1457-E WAS GROUND WATER N ENCOUNTERED? · -~) I~ 0 P E IF YES, AT WHAT DEPTH? Gross Net Depth to Net Reading Date Time Time Water Drop PERCOLATION RATE ~ (~.~utes/inch) TEST RUN BETWEEN 4 , FT AND 5 Z FT O & E ENL~iNEERING & DEVELOr'MENT CO. Box 90, Davis St., Eagle River, Alaska 99577 694-2774 or 688-2280 Russell Oyster 694-2774 Performed for: Name: Legal Description: Earl Ellis SOIL LOG 688-2280 ,/~ Z'- Z/"~/'~/~ Tel. No. ~2~ -.z-~.:~-~ Depth (feel) Soil Characteristics 0 1 2__ 3 4__ 5__ 6__ 7__ 8__ 9__ PLOT PLAN PERC. TEST 14__ 15__ 16____ Ground Water Encountered: Proposed Installation: Comments: Performed by: __ Yes No /,J If yes, what depth Seepage Pit Drain Field 'V This well is produc!n9 ' oallons ¢ater per hour MOON DRILLING BOX 3370 pALMER, ALASKA 99645 TELEPHONE 745-4071 INVOICE Set purnp (~ feet. INVOICE NO. DATE YOUR. P. O. NUMBER ~ ~i (,' glk, Su f~,,:'-~ LL LOG ~=" DEPTH DEPTH DEPTH CASIN FORMATION IN FT. CA$1N FORMATION IN FT. CASI~ FORMATION IN FT. '. ~ ! . lOl ,d i 201 mi /' '.!. 102 i 202 ~& ~ ~ 104 204 ~ ' 208 "106 ~8 i ~ 10B ~ 209 ~6 i i '110 ~ 210 '" 11 "' 1~ ~ 11~ i ...... 218 ~ ' 1"114 214 14 i '115 ~ 215 '117 ~17 ~ / I ,. ~19 ) i 11~ : ~,~ 219 ' %~,, ~ 221 ' '126 [ 225 ~26 ~ i 126 226 '" __2? - ] '128'* - 228 26 ~ 120 ~ ~ ', 229 ~80 i ~30 '~' ~: 200 ~al ~ ( "181 *' 231 m82 t ~ 182 .... 2~2 83 ~ ~ 133 , ''. 233 .... 134 [ J ' 234 ~36 , i ~ r /; ; '~ "236 ~36 ~ "' 136 -./'~ ~6 ~a? ~ i '~' ' 137 ~ 237 38 ~ ~ 138 ~ .... 238 ~40 ' ~ . .140 ~ "240 --41 ~ ' ~ '~14~ ~ ' ~- ~ ~41 ~43 t ~ '--143 t 24~ ~44 ~ ~, ~44 ~ 244 " ~48 · 148 248 ~49 ~ ~ 149 , 249 152 ~ 252 ~ ~ k ~57 - 25? ~58 · . 158 ~ 258 --5~' ' ~ ,~ 159~ ~60 t ~ 160 260 ,, ~63 q ~ '162 " ~. '"262 ~ 164 , 264 ~64 ~ ~ 165 I 265' , ~66 [ / 166 266 ~67 ~ ~ 167 ~ 26~ ~68 ; 16~ 268 ~69 ~ ~ 169' ~ 269' ~70 ~, ~ 17o ~ 270 ~ ,, , ~ , 171 ~ 271 --?~ , 172 t 272 ~73 t ' ~ ' 173 , 278 ' ' 176 ' ' ' - 275 ~77 177 277 - ~78 ' " ~ ~' * ~ 178 ---278 79 ~ ,~ ,' 179 27~ --80 " 180 200 --OX ~ . .' ~' 181 281- ~82 " X82 282 __88 , 183 283~ 84 184 284 ~86 ' '~ ,:'.'~ ,. ~: _ 18~ ~ 288 , 187 ............................... 287 Il , ..., ;,,, ,,, ~89 , 189 289 ~0o , ~ ~oo ' ' ~oo ~91 ~ , 191 . _ 291 ~, 19a 298 --04 194' '~ 294 ~95 "~ '~'~ 196· 295 -- ~ ~ ,- ~' 196 ~ 296 ' 96 ~ " ; '' " 197~ 297 ~T ~ ' ~' "~' ~9s -- " ~98 ~g9 ~ , ~,. ,, ~'/~ 199 ~ 299 /: ?,..,/ ..... ~;.. per f~t AMOdNi''' '" (':' '/ -" - ' ' PLEASE PAY FROM THIS INVOIC /' r * , ) .-~'~' ' ....... :Z ........... • • GE 0,,• Municipality of Anchorage � 't On-Site Water and Wastewater Program < mil I (907) 343-7904 SAFETY Certificate of On-Site Systems Approval Parcel I.D. 051-281-75 Expiration Date: / I 1 CO I 1. GENERAL INFORMATION Complete legal description Benson #3 Lot 7 Location (site address) 17824 Kamkoff Ave Current Property owner(s) David Barber Day phone Mailing address 141 County Club Dr. Crawfordville, FL 32327 Real Estate Agent Day phone 2. TYPE OF DWELLING: 0 Single Family (w/wo ADU) ❑ Duplex ❑ Multiple Dwellings (Single Family and/or Duplex) 3. NUMBER OF BEDROOMS: 3 4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL: Individual Well Q Individual 0 Individual Water Storage ❑ Holding Tank ❑ Community Class Well ❑ Community ❑ Public Water System ❑ Public Sewer ❑ WaiverNariance request for: Distance: Received by / Q Date: s/l /)Q) COSA to be released to the engineer,unless otherwise requested by th gineer. COSA Fee $ Seo Waiver Fee $ Date of Payment G/0- (' Date of Payment Receipt Number C.9 1.5- 13 Receipt Number COSA# © C �� 303 Waiver# 5. STATEMENT OF INSPECTION BY ENGINEER As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation, based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application, shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate for the number of bedrooms and type of structure indicated herein. I further verify that based on the information obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water supply and/or wastewater disposal system is(dre) in compliance with all applicable Municipal and State codes, ordinances,and regulations in effect at the time of installation. In conducting an adequacy test,I attempt to provide a thorough,conscientious engineering analysis of the system in accordance with MoA COSA guidelines and regulations.The reported results describe the performance of the system under the conditions encountered at the time of the test, and separation distances measured to readily identifiable features. The operational life of all wells and septic systems depend on the local soil condition,ground water levels that may fluctuate during the year,and the water usage of the family being served by the system.These conditions are outside the control of the evaluator of this system. All systems eventually fail and satisfactory test results do not guarantee future performance of the system,nor do they guarantee that there are no hidden defects or encroachments.Therefore we cannot provide any warranty for future performance, nor can we estimate remaining life of the system. The content of this report is for the sole benefit of the owner listed above. Name of Firm Pannone Engineering Services LLC Phone (907) 272-8218 Address P.O. Box 100217, Anchorage Ak. 99510 Engineer's Printed Name Steven R Pannone Date 08/10/2018 ='� OF AL Ak Qtt 6. DSD SIGNATURE / --`110b- * � System#1 Approved for bedrooms —�� •Steven R. Pannone: System#2 Approved for bedrooms 99�• CE—..... x/ AMV Disapproved • ��ki`�`S`�i�+'" Conditional approval for bedrooms, with the following stipulations: �` �1r ,1�( /. ON-SITE "G WATER AND cr. WASTEWATER PROGRAM c r. mac. By: '_—.r � / , Original Certificate Date: ! b-t The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work. 7. ATTACHMENTS: COSA Checklist X Nitrate Advisory Septic System Advisory Arsenic Advisory Well Flow Advisory Other COSA blue sheet_f c If more than 1 septic system is on the lot: COSA Checklist# 1 of 1 Structure served by this system 1 Certificate of On-Site Systems Approval Checklist Legal Description: Benson #3 Lot 7 Parcel ID: 051-281-75 A. WELL DATA Well type Private If A, B, or C provide PWSID# Well Log (Y/N) Y Date completed 09/17/83 Sanitary seal (Y/N) Y Wires properly protected (Y/N) Y Total depth 175 ft. Cased to 77 ft. Casing height (above ground)1 8+ in. FROM WELL LOG AT INSPECTION Date of test 09/17/83 06/22/18 Static water level 70 ft. 68.4 ft. Well production 4 g.p.m. 2'6 g.p.m. WATER SAMPLE RESULTS: Coliform NEG colonies/100 mL Nitrate 5.06 mg/L Arsenic NDug/L Date of sample: 06/22/18 Collected by: PES B. SEPTIC/HOLDING TANK DATA Tank Type/Material Septic/SteelDate installed 09/14/83 Tank size 1000 gal. Number of Compartments 2 Cleanouts(Y/N) Y Foundation cleanout(Y/N) Y Depression over tank(Y/N) N High water alarm (Y/N) N/A Date of pumping NEW Pumper N/A C. ABSORPTION FIELD DATA Date installed 09/14/83 Soil rating (g.p.d./ft2 or ft2/bdrm) 225 SF/BR System type DEEP TRENCH Length 48 ft. Width UNK ft. Gravel below pipe 7 ft. Total depth 9.96 ft. Eff. absorption area 675 ft2 Monitoring tube Y Depression over field Date of adequacy test 06/22/18 Results (Pass/Fail) PASS For 3 bedrooms Fluid depth in absorption field before test 20 in. Water added 450 gal. New depth 19 in. Elapsed Time: 1440 min. Final fluid depth 19 in. Absorption rate >= 450+ g.p.d. N Any rejuvenation treatment(past 12 mo.) (Y/N &type) If yes, give date D. LIFT STATION Date installed Size in gallons Manhole/Access (Y/N) "Pump on" level at in. "Pump off' level at in. High water alarm level at in. Datum Cycles tested Meets alarm&circuit requirements? E. SEPARATION DISTANCES WELL ON LOT TO: Septic tank/lift station on lot 100+ On adjacent lots 100+ Absorption field on lot 100+ On adjacent lots 100+ Public sewer main N/A Public sewer manhole/cleanout N/A Sewer/septic service line 25+ Holding tank N/A Animal containment areas 50+ Manure/animal excrete storage areas 100+ SEPTIC/HOLDING TANK ON LOT TO: Building foundation 5+ Property line 5+ Absorption field 5+ Water main 10+ Water service line 10+ Surface water 100+ Wells on adjacent lots 100+ ABSORPTION FIELD ON LOT TO: Property line 10+ Building foundation 10+ Water main 10+ Water Service line 10+ Surface water 100+ Driveway, parking/vehicle storage !0+ Curtain drain 50+ Wells on adjacent lots 100+ F. COMMENTS *Below existing grade to bottom of sump. G. ENGINEER'S CERTIFICATION 'f«3 OF ALI k I certify that I have determined through field inspections and ,SAM+ ka ....4--.*4—•:v y+r review of Municipal records that the above systems are in 0*: 49 TH /\ •.*y conformance with MOA COSA guidelines in effect on this date. d +�•.1 •• f Steven Pannone 1 Engineer's Printed Name Steven •. 'innone Date 8/10/2018 li��l9.. CE-8149. ' 1 r l, \"i�4� COSA canary sheet_2-6-15.doc MUNICIPALITY OF ANCHORAGE DEVELOPMENT SERVICES DEPARTMENT + • F 907-343-7904 On-Site Water and Wastewater Section 1 Fax: 343-7997 www.muni.org/onsite Nitrate Advisory Certificate of On-Site Systems Approval # OSC181303 Subdivision: Benson #3, Lot: 7 A water sample revealed a nitrate concentration of 5.06 milligrams per liter (mg/L). The Environmental Protection Agency (EPA) has established a maximum contaminant level (MCL) of 10.0 mg/L for public drinking water systems. While private wells are not subject to this regulation, EPA standards are based on existing health information and can therefore be used to gauge the relative quality of water from private wells. Please see the attached "Nitrate Fact Sheet" for important information regarding nitrate. This advisory must be attached to all copies of the subject Certificate of On-Site Systems Approval. Mailing Address: P.O.Box 196650*Anchorage,Alaska 99519-6650*www.muni.org FND. FND. KAMKOFF AVENUE NO. 5 REBAR N 89 57' 43" W 249.20 4 NO. 5 REBAR �pI 0 WELL f'Ne GRP‘jBL 30' TELE. & ELEC. ESM'T. cQ QcP 1...... ' ` C.ONCRFT6. ` l h� pEC� 8�W ° CO SINGLE FAMILY - 2 8 2 r^ FRAME HOUSE Z ", O CO Z . W S' 0 8 14.1114441. 0 ° O qE DECK OO W ,ez C. W J O Wu /. V O w LOT 4A 0 GRAVEL . co sO DRIVEWAY C9,Fti O LEAN-TO ds �G-E. O s BARN D I 'OS • FND. NO. 5 REBAR N 89 11' 38" W 298.35 LOT 8 AS-BUILT SURVEY 1" = 30' NO CORNERS SET THIS DATE o00ooOp� I HEREBY CERTIFY THAT I HAVE PERFORMED A SURVEY �d� OF A t N OF THE FOLLOWING DESCRIBED PROPERTY 00 's .'9s�� LOT 7, BENSON NO. 3 SUB. ( PLAT 83-365 ) fOfp49 TH %� OO ANCHORAGE RECORDING DISTRICT, ALASKA, AND THAT THE O- /� t/ Q VISIBLE IMPROVEMENTS SITUATED THEREON ARE WITHIN Q S/4Ni,,ii /JliLt THE PROPERTY LINES AND NO VISIBLE ENCROACHMENTS v. .O THE INFORMATION HEREON IS FOR THE USE OF LENDING INSTITUTIONS SPECIFICALLY TO SHOW ANY EXIST OTHER THAN NOTED. 0 m • �° CONFLICTS BETWEEN EXISTING STRUCTURES AND PLATTED LOT LINES AND/OR EASEMENTS;AND IS O - SHANE A.HOLT .' A O DATED AT ANCHORAGE,ALASKA THIS 10 TH DAY OF Q4�� LS-6914 4� NOT TO BE USED FOR POSITIONING ADDITIONAL STRUCTURES,IMPROVEMENTS,OR FENCELINES. — EASEMENTS OF RECORD,OTHER THAN THOSE APPEARING ON THE RECORD PLAT,ARE NOT SHOWN _AUGUST , 2918. 4p ap . pd_o HEREON(UNLESS INDICATED) ro/es siona\‘'a� NOTE: FENCELINES THAT MAY APPEAR ON THIS DRAWING ARE NOT TO BE USED TO DETERMNE 4 ftS1. 05' PROPERTY LINES OR POSITION ADDITIONAL IMPROVEMENTS. HOLT LAND SURVEYING ANY PAVING SHOWN HEREON MAY BE APPROXIMATE DUE TO EXCESSIVE SNOW AND/OR ICE. 9309 GROVER DRIVE ANCHORAGE,AK 99507 11801, FB 149-63, 189-59, SCAN 345-5513 MUNICIPALITY OF ANCHORAGE Department of Health & Human Services DIVISION OF ENVIRONMENTAL SERVICES 343-4744 Parcel I.D. # CERTIFICATE OF INSPECTION FOR HEALTH AUTHORITY APPROVAL OF ON-SITE SEWER AND WATER FACILITY FOR SINGLE FAMILY DWELLING 1. GENERAL INFORMATION (Must be completed prior to submittal) (a) Legal Description (include lOt, block, subdivision, section, township, range) Lot 7; Benson Subdivision ~ Location (address or directions) South Birchwood/Hillcrest/Shims/Kamkoff - last house on left (b) Property owner ~ Dias Telephone'(home) 688-4165 Mailing Address P.O. BOx 1344~ Eagle Rive% Alaska~ 99577 Business (c) Lending Institution Telephone Mailing Address (d) Real Estate Compan~y and Agent HERITAGE REAL ESTATE/Suzanne Cool Address 18550 Eaqle River Road, Eagle River, Alaska 99577 Telephone 694-4994 (e) Mail the HAA to the following address: (or check here,~;~ if hold for pick up.) List contact person and day phone number below: S & S ENGINEERING/694-2979 17054 Eagle River Loop Road, Suite 204 Eagle Riva_r: Alaska 99577 ordered by Mary Dias 2. TYPE OF RESIDENCE Single-Family,~ Number of bedrooms 3. WATER SUPPLY Individual Well [] Community [] Public [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to th legality and status. 4. SEWAGE DISPOSAL On-site J~ Public [] Community [] Holding Tank [] Note: If community well system, must have written confirmation from the State Department of Environmental Conservation attesting to the legality and status. 72-025 (Rev. 7/88) Page 1 of 2 ~ to ~ eaed 'HJOM S,Jeeu!6u@ leUO!SSe~oJd eqi u! suo!ss!lllO JO sJoJJe JOj elq!suodseJ leu s! eb8Joqouv ~o Xl!ledlo!un~ eql 'penss! s! eleo!J!),Jeo B ejo,t@q elep eZAleUe Jo suop, oedsu! lonpuoo 1ou op SHHO jo see~oldW=l 'slueweJ!nbeJ el8ls pue IeJepeJ u!e1Jeo ~jsp, es ol JepJo u! suo!lnlp, su! 6u!puel J!eql pub sewoq jo sJeseqoJnd el ~se:~Jnoo B 88 $!q~, seep SHHO eq.L '~>tselV jo eleiS eql u! peJels!beJ Jeeu!6ue leUO!SSejoJd luepuedepu! ue ~q e^oqe ~ qde~Se~ed u! ue^!6 suo!le~ueseJdeJ eql uodn ,~lUO peseq peleo!j!Jeo ts^oJdd¥ ~lpoqln¥ qll~eH senss! 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WELL DATA ~.~'~q~UNICIPALITY OF ~0~0~ Authority Approval (HAA) '~H~CKLIST - FEBRUARY 1984 343-4744 Legal Description: Well Classification If A, B, C, D.E.C. Approved (Y/N) Well Log Present ~N)" 7 ~C°mpleted ~ ~_ ~'~ - .~, Total Depth ['~ Cased to ~'~ Depth of Grouting I Static Water Level ~( ~- Pump Set At Yield Casing Height Above Ground \~- Electrical Wiring in Conduit~Ci~N) SEPARATION DISTANCES FROM WELL: To Septic/Holding Tank on Lot \ To Nearest Edge of Absorption Field on Lot To Nearest Public Sewer Line To Nearest Sewer Service Line on Lot Water Sample Collected by Water Sample Test Results Comments Sanitary Seal on Casing(i~N) "/ Depression Around Wellhead (Y~L~ ; On Adjoining Lots ~ ~:x::~- , On Adjoining Lots To Nearest Public Sewer Cleanout/Manhole ~ ~-~ ~¥..~C.~ t ~~¥-,, ; Date "~ "¢-":'1. - B. SEPTIC/HOLDING TANK DATA Date Installed '~- i'¢f-~"~ Size t ,-~',¢~_ ~- No. of Compartments Standpipes~/N) y Air-tight Capsd¢,'¢::~) Depression over Tank (Y~ ~ Pumping/Maintenance Contact on File (Y/N.), Holding Tank High-Water Alarm (Y/N) ~/',~z SEPARATION DISTANCES FROM SEPTIC/HOLDING TANK: Foundation Cleanout~N) pate Last Pumped ;for - Temporary Holding Tank Permit (Y/N) '~/.~ To WaterrSupply Well To Property Line To Water Main/Service Line To Stream, Pond, Lake or Major Drainage Course Comments ~'~--~ ~ ¢cc:~-- ~.%~,c5~, To Building Foundation To Disposal Field 72-026 (Rev. 7/88) Front Page 1 of 2 C. ABSORPTION FIELD DATA Soils Rating in Absorption Strata Date Installed Width of Field ~-,~" Square Feet of Absortion Area Depression over Field (Y/d~!~ Results of Last Adequacy Test Type of System Design "~.~-[- Length of Field ,~_~:pl Depth of Field ~ ~' t Gravel Bed Thickness Statndpipes Present dpH=N) "-/' Date of Last Adequacy Test SEPARATION DISTANCE FROM ABSORPTION FIELD: To Property Line I ~ ~ To Existing or Abandoned System on ; On Adjoining Lots ~c:~t ~ To Cutback (if present) ~"'~//~ To Water-Supply Well To Building Foundat~o~ "~ Lot To Water Main/Service Line \ ~=' ~'~¢~ To Stream, Pond, Lake, or Major Drainage Course To Driveway, Parking Area, or Vehicle Storage Area Comments D. LIFT STATION [~,.~, Date I~talled IF' Size in ~ On" "Pum. Dimensions High Water Alarm Level at Tested for Meets MOA Electrical Codes (Y/N) Comments Manhole/Access (Y/N) "Pump Off" Level at Vent (Y/N) Pumping Cycles during Adequacy Test. **Check Permitted Bedroom Rating Against HAA Request** I certify that I have checked, verified, or conformed to all MOA and HAA guidelines in e,.ff~ inspection. $ & $ ENGINEERING Company Eagle River, Alaska 99577 Date zy//~./~-~/,,~ ~, MOA No. / / - ~ 72-026 (Rev. 7/88) Back Receipt No. Waiver Fee: $ Date of Payment Page 2 of 2 MUNICIPALITY OF ANCHORAGE AND P S ION 1. ~ral Inf~tion ~pli~tion Date (a) Legal.Des_criDC~ion (inclu~de lot, block, subdivision, se¢~i.o,n, township, range_~ (c) Applicant is (che~ oB) ~nding Institution ~ ; ~r~il~r ~; Buyer ~; ~her ~ (e~lain); ~ (d) ~nding Institution /¢~/o;1~~ ~ T~,~epho~ ,,, (e) Real Estate Co. & Agent Address Telephone 2. Type of Residence Single-Family.~.. Number of ~drccms Multi-Family ~-~ Other (describe) 3. ~ter Supply Individual Well~ Community ~ Public Note: If ccnmunity ~11 system, must have written confirmation from the State Department of Environmsntal Conservation attesting to the legality and status. Is the ~11 adequate for the number of kedrocms specified in this HAA~ 4. Sewage Disposal ?nsite~ Public ~ Community ~--] Holding Tank ~ Is the ~stewater disposal system adequate fc~ the number of bedroc~s~'~$/, [Page I cf 2] 2-15-84 5. E~ngineering Firm Providing Inspections, Tests, tats and Information I oertify tha~-'~'"h~e~cked, verified, c~ conforrred to all MDA HAA Guidelir~s in Address ( ENGINEER SEAL) 6. DHEP Approval Approved for A~proved ~ Disapproved Terms of C~nditional Approval '?he Municipality cf Anchorage Department of Health and Enviror.,~ental P~_otection dices not guarantee, t,.h~ continued sal:isfactory perfo:~mance of the water supply and/or the wastewate~ disposal system. This apprc, val indicates that, as o~ the ,~alidaticr.~ clare show~ above, based on th~ data and info~mat'io~.~ furnished by an engir~er registered in the State of Alaska, the water supply and wastewate~ disposal system is safe and func.-- tional fo~ 'the numba~ of bedrocm~ and type cf struct ~t'e indicated. ( D~EP SEAL) 7. Mail~'~he t t foll~owing ad~ess: ~ KB2/d5/s [Page 2 of 2] 2-15-84 MUNICIPALITY OF ANCHORAGE (MOA) HEALTH AUTHO~TY APRROVAL (HAA) CHECKLIST - FEBRUARY 1984 Well Classificati~ Well Log P~esent · o al / 75' Static Water Level ~_~ ~ Casing ~ight ~ G~nd ~ Elee~i~l Wi~ing in :~nduit ~' ~p~ation Distan~s ~ ~11: MUNICIPALITY OF ANCHORA(3]~ DEPT. OF HEALTH & ENVIRONMENTAL PROTECTION RECEIVED Sanitary Seal on Casing~ Depression A~ound Wellhead To Septi¢~ Tank c~ Lot./~ ; Ckl Adjoining Lots..~/~'~?~' To Nearest Edge of Absorption Field on Lo~t /~ f~ ; On Adjoining Lots /%///// To Nearest Public Se~r Line ~//~ To Nearest Public Sewer Cc~ents / Be SEPTIC~ TANK DATA Date Installed~, '!q~4/&~ Size ~ Standpipes .. Ai~-tight Caps No. of Compartments ~ Foundation Cleanou~&~ Depression over Tank ( Date Last Pumped ~/~~ . . Holding Tank High-Water Alazml (.Y/N) ~f//~ Tempo~al"I Holding Tank Permit Separation Distanoes f~cm Septi.c/Hgldin% Tank: To Water-Supply W~ll /3~ ~ To Building Foundatior~ 2L~ /~. To P~ope~ty Line /O ~ To Disposal Field _ ~ /,'~ To WaterMain/ServiceLine ~///~ To~S~~Pond, T~e. C~ Major D~ainage Course Comments \\ [Page 1 of 2]~ L~ Ce ABSORPTION FIELD DATA Soils Rating in Abgorpt. ion Date Installed ~//y/~ Width of Field -- ~'~) " Square Feet of Absc~ption A~ea ~'~S~ Strata ~Type Of system Design ~/4~'~~ Length of Field ~ Depth of Field Gravel Bed Thickness Standpipes P~esent Depression over Field (~f~_y Date of Last Adequacy Test Results of Last Axfequacy Test -'%J~ ~ Separation Distanee f~cm Absorption Field: To Building F~un~ation ~~ To Existing c~ Abandoned System cn Lot /u/ / /~ ; On Adjoining Lots ~//~/ ~).~---L,/ To Water Main/Service Line .~///~' To Cutbank(if ~esent) l'J//t2~ To Stream/Pond/Lake/c~ Major D~ainage Course /~/ / ~k ' TO D~iveway, Parking A~ea, c~ Vehicle Stc~age A~ea v;~/ ~/_. -- O A3 /~t~DA/ Cc~ents D. LIFT STATION Date Installed Dimsnsions Size in Gallons /! f~ Manhole/Access (Y/N) "Pump On" Level at //I/ ! A/~ '?ump Off" Level at. High Wate~ Alarm ievel a~v y~ Vent (Y/N) Tested for P%(mping Cycles du~ing Adequacy Test. Meets M~A Electzical Codes (Y/N) Ccm~ents ** Check Pe~mitte.~ Bedrocm Rating Again. st HAA ~equest ** I certify thg~I h~v~e~ .d~k~d~ verified, c~ confomzed to all MOA HAA Guidelines in effect on the da~7~/~/on. SignedL/-~////~~,~./'~,~ .~ ...... "~ Date ~_~'/~ Company~/..S ~L ~ ~I.~:R~N~' ' MOA No. 2-15-84